“Periodontitis”

A bacterial infection known as "periodontitis" causes subsequent inflammatory reactions (Zandbergen et. al, 2013). These unfavorable reactions frequently have an impact on the alveolar bones and periodontal ligaments that are nearby. In the case that it is left untreated, the following loss of attachment structures may ultimately lead to tooth loss. The "P.I.C.O. Model" for clinical questions consists of four components: the "patient, population, or problem," the intervention or "prognostic factor," the "comparison or intervention," and the expected result of a particular review. Based on the P.I.C.O Model, the article takes a deeper look at a group of patients experiencing “periodontitis,” which is just but a bacterial infection that in context may be seen as a variation from a “eubiotic” human microbiome as well as inflammatory response to “dysbiosis.” Additionally, this “dysbiosis” may end up having adverse effects on systematic well-being. The main prognostic factor that this article considers is whether the equivalent effect of scaling and robot planning (SRP) does bring about microbial changes needed to maintain enduring permanence of clinical benefits.

As the main alternative for comparison with the intended intervention, the article tries to determine the effect of systemic prescription of amoxicillin and metronidazole to be used as adjuncts to scaling, and robot planning (SRP) compared to scaling and robot planning (SRP) alone. This is done as far as treatment outcomes, pocket depths, and clinical attachments are concerned.

On the question of what the research article intends to accomplish, improve or affect, it can be argued that the article intends to find out whether the combination of systematic antibiotics such as metronidazole and amoxicillin, that has attracted considerable clinical interests and research as previous studies suggest, and strict control of “supragingival plaque” in the course of treatment can bring about encouraging results when it comes to treating chronic periodontitis.

Research Design

By quantifying the problem through generating numerical data that can be converted to usable statistics, this publication used quantitative research design. This is since it tries to quantify the defined number of patients with periodontitis with an ultimate goal of evaluating the long-term efficacy of periodontal treatment. For instance, by choosing a selection strategy where research materials were independently screened by reviewers and most of them that somehow did fulfill all selection criteria processed for data extraction purposes, 20 clinical trials were selected, which included a total number of 747 patients from which data were derived for analysis. Based on this analysis, the researcher intended to evaluate in patients with periodontitis the evidence that concerns the effects of periodontal cure that includes scaling and robot planning (SRP) compared to scaling and robot planning (SRP) alone with clinical parameters of periodontitis. This was based on the factors employed for evaluation of the heterogeneity of the features of the different studies which included interventions and adverse events.

Quantitative versus Qualitative Research Designs

Qualitative research, also known as exploratory research, is used to gain an understanding of the core reasons, thoughts, and drives. It tends to provide intuitions into given problems or help in developing various ideas or suppositions necessary for potential quantitative research. To add on, qualitative research is used to unearth drifts in thoughts and ideas, and dive deeper into the problems. On the other hand, quantitative research is used to quantify the problems through producing numerical data that can be transformed to usable statistics. For instance, in this case, mean and standard deviations were extracted with the help of data extraction forms and consequent meta-analysis that summarized the outcomes.

Observational study designs, also known as “epidemiologic research designs,” are in most cases used to evaluate possible causality in exposure-outcome relations and hence impact precautionary measures. Observational study designs comprise of “ecological designs,” “cross sectional,” “case control,” “case crossover,” “retrospective” and “prospective” designs. On the other hand, interventional studies are usually eventual and are precisely designed to assess direct influences of treatment or preventive measures on an ailment. This research review, hence, can be categorized as an interventional study design because it tries to find out whether the combination of systematic antibiotics such as metronidazole and amoxicillin in the course of treatment can bring about encouraging results when it comes to treating chronic periodontitis. Some of the types of interventional study designs are “pre-post study design,” “non-randomized trial study design,” and “randomized controlled trial study design.”

Just as with “quantitative designs,” there exist numerous varieties of qualitative designs. Some of the types of qualitative research designs include “ethnography,” “phenomenological,” and “case study” designs.

Level of Evidence/ Hierarchy of Evidence

This research publication can be ranked as “evidence from systematic reviews of all relevant randomized controlled trials (RCT’s).” When assessments were carried out in the course of the data analysis, some of the articles did provide insufficient data after which subsequent authors were contacted for extra data. To guarantee precise estimates, any data approximations in figures were not taken into consideration. Upon carrying out of quantitative and “meta-analysis” that was intended to summarize between group outcomes, the results realized a 95% confidence interval. Since the confidence interval includes 1, the outcomes show that there is no increased prevalence. Therefore, a level of evidence for systematic review of relevant “Randomized Controlled Trials (RCT’s) is a better option and does provide higher evidence for testing the hypothesis of the association between the prescription of systematic antibiotics such as metronidazole and amoxicillin and the treatment of chronic periodontitis.

Various levels of evidence exist. And these include; “evidence obtained from more than one well-designed Randomized Controlled Trial (RCT).” This includes virtual-randomized processes that may comprise of substitute allocations. It is usually regarded as the most reliable evidence depending on the effectiveness of the treatment in question. Besides, it entails evidence obtained from more than one appropriately designed randomized controlled trial. Secondly, “evidence from well-designed case-control and cohort studies.” This includes retroactive and sporadic time-series that may bring about a change in tendency attributable to intrusion. It might also involve case-control studies as well as health services study that does include variations for possible mystifying variables. Thirdly, “evidence from systematic reviews of descriptive and qualitative studies.” To add on, “evidence obtained from comparisons between times or places with or without the intervention.” Dramatic outcomes in experimentations that are not controlled may as well be included in this category. An additional level is that of “opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.” Lastly is the “evidence of observational studies without controls.” For instance, cohort studies without controls. These are simply studies that tend not to have any control group. They are otherwise termed as case series or tales.

Search criteria

The specific search criteria used in the research is a case of a search string for “one concept” systematic reviews. The publication was all-inclusive as it came to identify “Periodontitis” as a bacterial infection and all the ways through which it could be cured by the use of a combination of antibiotics such as metronidazole and amoxicillin, and ultimately the effects of periodontal cure. In the research, website sources were used to look for studies, something that eventually led to the satisfaction of the survey purpose. The three lists included “MEDLINE-PubMed,” “EMBASE,” and “Cochrane-CENTRAL.”

Closing

In conclusion, I have come to learn a lot from this research publication. For example, I was able to understand and deduce clinical studies that are imperious for practicing evidence-aligned dental hygiene. And because of this, I will change the way I practice clinical dental hygiene because I am now aware of all the dangers that come with poor dental hygiene, what needs to be done to curb them and the effects of the respective treatments. And it is important to note that this is what makes the publication credible, as it answers the questions, why, how, when, and what.

References

Zandbergen, D., Slot, D. E., Cobb, C. M., & Van der Weijden, F. A. (2013). The clinical effect of scaling and root planing and the concomitant administration of systemic amoxicillin and metronidazole: a systematic review. Journal of periodontology, 84(3), 332-351.